Program Evaluation Research Articles

Enhanced Cross-Entropy Exponential TODIM Framework for Interval-Valued Pythagorean Fuzzy Information and Applications to Art Teaching Quality Evaluation

Art teachers in preschool education need to possess not only high professional competence but also a commitment to continuous learning to enhance their comprehensive teaching abilities. The art teaching quality evaluation in preschool education programs at vocational colleges is multiple-attribute group decision-making (MAGDM). Currently, the Exponential TODIM and cross-entropy approach was employed to address MAGDM. Interval-valued Pythagorean fuzzy sets (IVPFSs) serve as a strategy for characterizing uncertain data during the art teaching quality evaluation in preschool education programs at vocational colleges. In this study, the interval-valued Pythagorean fuzzy number cross-entropy Exponential TODIM (IVPFN-CE-ExpTODIM) approach is developed to bring up MAGDM problems under IVPFSs. To validate the proposed method, a numerical study is conducted on the art teaching quality evaluation in preschool education programs at vocational colleges.

Penerapan Manajemen Layanan Karir di Madrasah Aliyah Negeri

Career service management is a critical element in helping students plan their futures. This research aims to explore and understand career service management at Madrasah Aliyah Negeri in Sleman, focusing on the stages of planning, implementation, and evaluation of career programs. Additionally, this study examines the factors that influence students’ career goal-setting, including the roles of parents, teachers, and industry partnerships. A qualitative descriptive approach was employed, with data collected through field observations and structured interviews with the school principal, vice-principals, career guidance counselors, and several students. The results indicate that career service management at MAN Sleman is conducted systematically through collaboration between the school, parents, and external partners such as industry professionals. Parental support and guidance from career counselors significantly affect students in choosing careers that align with their interests and abilities. Career programs, including workshops, industrial visits, and individual counseling, were successfully implemented, although some challenges remain in the evaluation process, particularly regarding students' anxiety in career decision-making. This research contributes to the development of more effective career services in schools and serves as a reference for other institutions seeking to improve their career services to better meet students’ needs.

Program design and exemplary practices for preparing Teachers of Color and Indigenous Teachers

Research on Teachers of Color and Indigenous Teachers (TOCIT) has gained traction in recent years in educational scholarship. Yet very few studies have evaluated teacher education programs that prepare TOCIT within the U.S. context or have focused on the promising pedagogical practices used to prepare TOCIT. The challenge of doing program evaluation resides in the different institutional contexts and the limited time teacher education researchers have to look holistically and systematically at program design and evaluation. However, we can talk about exemplary practices that have been supportive in preparing TOCIT. This article describes various teacher education pedagogical and theoretical practices that have been used in the preparation of TOCIT within different types of teacher education programs. We discuss two common types of teacher education programs—traditional and alternative. We also discuss the policy landscape for these teacher education program types, focusing on practices used in TOCIT preparation. Recommendations are suggested for policymakers to work intentionally toward creating a diverse teacher workforce and providing support—resources and financial—throughout teachers’ careers. Keywords Teachers of color, Indigenous teachers, alternative certification programs, Grow Your Own, residency programs

Perceived Success of Mental Health Court Programs: Examinations of the Perceptions of Mental Health Court Administrators as Compared to Drug Court Personnel

Mental health courts are a type of treatment court that utilizes the principles of therapeutic jurisprudence to provide a treatment-oriented approach rather than the traditional adversarial approach. This study sought to explore mental health court administration through the experiences and perceptions of the court administrators as it compares to a previous study ( N = 114) conducted about drug court administrators in 2008 (Nored & Carlan). The available literature demonstrates positive results from these programs, but many aspects of their functioning and what makes them function well remain unknown. Mental health court administrators ( N = 126) were surveyed using an electronic questionnaire. The questionnaire asked questions about administrator demographics, perception of program success, and perceived levels of support. Mental health court administrator responses were compared to the results of the drug court administrators, finding similar results in perception of success and perceived levels of support for the program. In both studies, administrators perceived their programs as successful and considered local support to be highest and of most importance. Some notable differences were found in court administrator demographics in regard to age, race, and gender. Implications for court administration, hiring, and program evaluation are discussed.

A parenting program delivered through existing community-based peer groups to improve early child development in Homabay and Busia Counties, Kenya: study protocol for a cluster-randomized controlled trial

BackgroundPoor early childhood development (ECD) is a major global health concern that is associated with various adverse outcomes over the lifecourse. Parenting interventions especially during the earliest years of life can benefit ECD. However, there is limited evidence from Kenya about the effectiveness of parenting interventions for improving ECD outcomes especially across rural disadvantaged communities. This paper describes the study protocol for an impact and implementation evaluation of a community-based group parenting program that aims to improve ECD in rural Kenya.MethodsWe will conduct a cluster-randomized controlled trial to determine the effectiveness of a parenting program for caregivers of young children in Homabay and Busia counties in Western Kenya. Sixty-four village clusters will be randomly assigned to either the parenting intervention arm or the waitlist control arm with stratification by county. In each village, 10 primary caregivers with a child aged 0–24 months will be enrolled. The parenting program will be delivered through existing peer groups within communities whereby caregivers will receive counseling and psychosocial support to enhance their parenting skills and wellbeing to in turn promote ECD. The intervention curriculum comprises 21 sessions targeting various nurturing care messages, including early learning, responsive caregiving, child nutrition, health, protection, and caregiver mental health. Group sessions are facilitated by a trained volunteer biweekly for a total of 11 months. The primary trial outcome is an overall measure of ECD using the Global Scales of Early Development long form version. Secondary outcomes include various caregiver outcomes (e.g., parenting practices, mental health) and other child outcomes (e.g., socioemotional development, dietary diversity). All outcomes will be assessed at baseline and endline. We will also conduct a qualitative implementation evaluation at endline and interview various stakeholders to assess program fidelity, quality, and sustainability.DiscussionThis trial will evaluate the effectiveness of a parenting intervention on ECD and caregiving outcomes and assess program implementation quality as delivered through existing community-based peer groups. This study will provide rigorous evidence that can be used to inform scale-up of this program model that leverages existing community social networks and resources for improving caregivers’ parenting skills and promoting ECD in rural Kenya and other similar settings across LMICs.Trial registrationClinicalTrials.gov #NCT06165315. Registered on December 11, 2023.

Feasibility, acceptability and preliminary evaluation of a user co-facilitated psychoeducational programme: a feasibility proof-of-concept randomised control trial

BackgroundMental health settings are increasingly using co-facilitation of educational group interventions in collaboration with patient partners and service users. However, despite promising results, limited information is available regarding the feasibility and satisfaction levels of these programmes among adults newly diagnosed with attention-deficit hyperactivity/impulsivity disorder (ADHD). Hence, this study aimed to determine the feasibility, acceptability, and preliminary effects of a user co-facilitated psychoeducational group programme for adults diagnosed with ADHD.MethodsThis feasibility proof-of-concept randomised controlled trial recruited outpatients from a Norwegian community mental health centre. Outpatients randomised to the intervention group (IG) received a psychoeducational programme supplementing Treatment As Usual (TAU), while the control group received TAU. Feasibility was determined by the acceptance rate, adherence rate, and dropout rate. Acceptability was measured with the Client Satisfaction Questionnaire and a 3-item scale measuring satisfaction with the received information. To test the preliminary effects, self-efficacy, symptom severity, and quality of life were measured at baseline and pre- and post-intervention.ResultsFeasibility was demonstrated; most of the patients were willing to enrol, participants attended 82% of the psychoeducational programme, and only 13% dropped out of the study. The between-group analyses revealed that the IG reported significantly greater mean satisfaction than the CG. Moreover, the intervention group was more satisfied with the information they received during the psychoeducational programme. Concerning the preliminary effects, the linear mixed model showed improvement in quality of life (the subscale relationship); however, other patient-reported outcomes did not show improvements.ConclusionsThis proof-of-concept randomised controlled trial supports the feasibility and acceptability of the user co-facilitated psychoeducational programme for patients newly diagnosed with ADHD in an outpatient setting. While preliminary findings indicate promise in enhancing patient-reported outcomes, a larger study is warranted to assess the intervention’s effectiveness rigorously.Trial registrationNCT03425, 09/11/2017.

Training an Embedded Workforce to Realize Health System Impacts and the Promise of Learning Health Systems Comment on "Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program"

Learning health systems (LHSs) are designed to systematically integrate external evidence of effective practices with internal data and experience to put knowledge into practice as a part of a culture of continuous learning and improvement. Researchers embedded in health systems are an essential component of LHSs, with defined competencies. However, many of these competencies are not generated by traditional graduate/post-graduate training programs; evaluation of new LHS training programs has been limited. This commentary reviews and extends results of an evaluation of early career outcomes of fellows in one such program designed to generate impact-oriented career pathways embedded in healthcare systems. Discussion considers the need for increasingly rigorous evaluation methods to ensure production of high-quality professionals ready for system engagement, the importance of training and preparing other LHS stakeholders as effective partners and evidence users, and the promise and challenges in advancing the science and practice of embedded research in LHSs.

Effect of the Partners in Play Intervention on Parents' Autonomy-Supportive Guiding Behaviour and Children's Self-Regulation.

Compelling evidence supports the foundational importance of early self-regulation (SR). It also supports parents in the home environment as having the foremost influence on early development. Yet, prevailing approaches to support early SR growth have tended to leverage early education and clinical settings. Partners in Play (PiP) was developed as a sustainable approach for parents to learn how and when to support children through experiences of self-regulation challenges in the home learning environment. This study reports the first randomised control trial evaluation of the PiP program, with 21 parent-child dyads (consisting of twelve girl-mother dyads, eight boy-mother dyads, and one boy-father dyad; mean child age = 4.12 years, SD = 0.65). Dyads were randomised to a PiP intervention group (n = 10), which entailed four online parent information sessions and four out-of-home guided practice dyadic play sessions across 8 weeks, or an active control group (n = 11). The primary outcome was parent autonomy support, and the secondary outcome was child SR. Results indicated a significant increase in parents' use of autonomy support and a non-significant but moderate-sized effect on child SR. This innovative proof-of-concept program and evaluation provides a roadmap for effecting change in parental support during children's play, to the prospective benefit of important abilities such as child SR. Analyses show promise for a parent-based model toward parent behaviour change and child SR improvement.

Building Frontline Capability for Shared Decision-Making (SDM) in a Major Academic Oncology Center Caring for People With Non-Small Cell Lung Cancer: Performance Outcomes of a SDM Simulation Training Program.

There is a growing body of evidence on shared decision-making (SDM) training programs worldwide. However, there is wide variation in program design, duration, effectiveness, and evaluation in both academia (ie, medical school) and the practice setting. SDM training has been slow to integrate in practice settings. A pilot study of 6 multidisciplinary clinicians was conducted using quantitative and qualitative methods to evaluate changes in participant understanding and implementation of SDM in the practice setting. A 2-rater criterion-based evaluation method was used to assess a simulation-based case study role-play program using 7 domains of SDM pre and post training. The authors assessed whether clinicians addressed each of the 7 domains or what fraction of each domain was addressed as part of their simulation case study role-play performance. Focus groups were conducted pre- and postintervention to provide feedback to participants and to understand the clinician experience in greater detail. The increase in improvement in SDM ranged from 17% to 37%, and 7 of 8 domains for which participants were rated showed significant improvement. The areas of greatest improvement were seen in determining a patient's goals/preferences, including risk tolerance regarding treatments (+37%) and values and self-efficacy (+37%). The results of this study reveal a significant shift in clinician awareness of a patient's goals, preferences, and values. Postintervention, clinicians began to understand the value of building a partnership with their patients whereby the patient becomes an active participant in their clinical care.

Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study.

Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic. The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada. This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization-Five Well-Being Index. The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction. The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada. PRR1-10.2196/44368.

A qualitative investigation into the effectiveness of a housing navigator program linking justice-involved clients with recovery housing

BackgroundRoughly 24–36% of people who are incarcerated in the U.S. are formally diagnosed with opioid use disorder (OUD). Once released, individuals involved with the criminal legal system (CLS) face increased risks of return to use and fatality and are 129 times more likely to die from an overdose within the first two weeks of release compared to those without CLS involvement. People who are CLS-involved and who are seeking a recovery living environment can access temporary stable housing through recovery homes. However, entering a recovery home can be difficult due to fragmentation among recovery housing organizations and their non-uniform application and screening procedures. A navigation pilot program was implemented to provide clients with recovery home placement advice, pre-screening, and referrals in Cook County, IL. Existing research on recovery homes has rarely examined the importance of recovery housing navigation for enhancing service engagement among CLS-involved individuals receiving medications for OUD.MethodsSemi-structured qualitative interviews were conducted with 22 clients and three recovery housing navigators as part of a program evaluation of the navigation program pilot. Qualitative software was used to organize and qualitatively analyze transcripts through several rounds of coding producing emergent themes, which were then triangulated, and expanded using navigator data.ResultsClients seeking recovery home services reported multiple prior challenges securing safe and supportive recovery living environments. Despite low initial expectations, clients described their interactions with housing navigators in favorable terms and felt navigators worked with them effectively to identify and meet their housing and substance use needs in a timely manner. Clients also commented on their partnerships with the navigator throughout the process. Interactions with navigators also calmed fears of rejection many clients had previously experienced and still harbored about the process, which bolstered client-navigator relationships and client motivation to engage with additional services.ConclusionEvidence from this study suggests recovery home navigation can improve the speed and efficiency with which clients are connected to appropriate services that are tailored to their specific needs as well as increase client motivation to engage with a myriad of recovery services.

Evaluation of Nutrition Supplementation and Nutrition Education Program in Preventing Malnutrition in Toddlers

Malnutrition in children under five is a serious global health problem, especially in developing countries. In Indonesia, the prevalence of stunting in 2020 reached 31.8%, which is second in Southeast Asia after Timor Leste. However, this figure has decreased to 21.6% in 2022, according to data from the Indonesian Ministry of Health. This study aims to evaluate the effectiveness of nutrition supplementation and nutrition education programs in preventing malnutrition in children under five. This research design is an evaluative design with a cross-sectional approach to obtain an overview at one time of the nutritional status of children under five years of age, program implementation, and results achieved. The input of the number of nutrition workers is lacking, the Puskesmas needs 1 community health worker, the equipment owned is still lacking in the laboratory section and must request procurement from the City or Provincial Health Office and funds for MT distribution are not yet available, the output is not yet on target and the program coverage has not yet reached the set achievement indicators. Suggestions for the Padang City government, especially the Padang City Health to procure facilities and infrastructure that are lacking in puskesmas, while for the Padang Health Center must conduct counseling on the importance of PMT-P so that the MT provided right on target.

Evaluation and Supervision of Tutoring Services at Junior High School 7 Malang

Evaluation of the tutoring program is an important part of assessing the extent to which the tutoring program that the BK SMPN 7 Malang teacher provides to students has been implemented. This evaluation aims to determine the suitability of the tutoring program that has been carried out by guidance and counseling teachers at SMPN 7 Malang based on the six standards and criteria for professional counselors set by the Indonesian Guidance and Counseling Association (ABKIN) as an adaptation of the program evaluation set by the South Carolina Guidance and Counseling Program Model. This research uses quantitative methods. The technique used in collecting data uses instruments, which in this research were carried out and shared directly in the form of a Google Form. The instrument used in collecting research data is a tutoring evaluation instrument that has already been used with adjustments made by the current evaluator in an effort to achieve a better tutoring evaluation instrument. The results of the evaluation of basic tutoring services have been implemented fully and entirely, with a percentage of 86.26%.

Innovative Program Evaluation: Factors Associated with Primary Care Project Completion to Advance Pharmacist Clinical Services Integration

Innovative Program Evaluation: Factors Associated with Primary Care Project Completion to Advance Pharmacist Clinical Services Integration

Meeting Social Needs in a Crisis Context: Lessons Learned from Integrating the 'Take Care Initiative' into New York City's Testing and Contact Tracing Program.

The COVID-19 pandemic highlighted the importance of addressing social needs in a crisis context. Some US jurisdictions integrated a social service component into case investigation and contact tracing (CI/CT) programs, including the New York City (NYC) Test & Trace (T2) Program; the Take Care initiative referred NYC residents who tested positive or were exposed to COVID-19 to services to support isolation and quarantine and meet basic needs. More research is needed to determine effective implementation strategies for integrating social needs provision into CI/CT programs. To identify barriers and facilitators to the implementation of the Take Care initiative, we conducted key informant interviews with program staff, community-based organization partners, and cases and contacts as part of a larger evaluation of the T2 program. Interviews were recorded, transcribed, and analyzed using rapid qualitative methods. Key facilitators to implementation included utilizing a case management software system, employing strategies to encourage service uptake, leveraging cross-agency collaborations, and partnering with community-based organizations for resource navigation. Barriers identified included external management of the software system, challenges reaching and engaging the public, administrative complications due to shifting collaborations, and management of CBO partners' structure and hiring. Based on our findings, we provide recommendations to support effective planning and implementation of social needs service provision in a crisis context. Future research should focus on testing promising implementation strategies highlighted in this study and applying them to varied contexts and crisis situations.

Dynamics of Satisfaction with the Simulation Course on Basic Medical Manipulations

This study presents a comparative analysis of the survey data of the 2nd year medical university students who completed a simulation course on basic medical manipulations for the period from 2018 to 2023. The purpose of the study is to assess changes in students' perception and satisfaction with this course, as well as to identify trends and factors influencing their opinion. The study highlights the importance of regular monitoring and evaluation of educational programs to ensure that they meet the needs of students and improve the quality of medical education.

Evaluation of a perinatal palliative care program by SWOT analysis.

Perinatal Palliative Care (PPC) is individualized medical-nursing care aimed at improving the quality of life of newborns with life-limiting conditions and to support their families. This study draws on the analysis of the experience gained over ten years by a service of PPC called the "Percorso Giacomo" (PG). We employed a SWOT analysis to identify the strengths, weaknesses, opportunities, and threats of the PG through a systematic retrospective review of 48 cases followed by the program over the course of 10 years, 21 unsolicited parents' narrative and 27 experts' point of view. Main strengths of the program were communication and parents' involvement in shared decision-making. Main weaknesses included lack of knowledge of the presence and the role of the PG and lack of resources. For opportunities, the PG proved to be an innovative choice for pregnancies with a fetal life-limiting diagnosis, however threats were identified such as lack of knowledge of PPC and delayed referrals. The analysis by SWOT method of the 10-year experience of the PG allowed the identification of limitations and areas of improvement, however demonstrated that the PG provided beneficial services to women faced with fetal life-limiting diagnoses. Perinatal Palliative Care (PPC) practice and literature on this subject is still limited. This study offers features of the 10-year experience of the Percorso Giacomo (PG), a service of PPC, through a SWOT analysis. By identifying strengths, weaknesses, opportunities and threats of the PG, the study shows limitations and areas of improvement but also benefits of a PPC service to women with fetal diagnosis of life-limiting condition and may allow replication in other institutions.

A - 33 Impact of Cognitive Stimulation Therapy on Neuropsychiatric Symptoms and Everyday Functioning in a Veteran Sample

Abstract Objective Cognitive stimulation therapy (CST) is a well-supported nonpharmacological intervention, found to improve or maintain global cognition, daily functioning, and quality of life with persons with dementia. There are fewer studies assessing the effect of CST on neuropsychiatric symptoms; however, pilot studies have identified improvement in depression and anxiety in studies of persons with Alzheimer’s disease. The purpose of this program evaluation was to evaluate the impact of CST on neuropsychiatric symptoms and everyday functioning is a veteran sample. Method Twenty-six male veterans diagnosed with cognitive disorder (84.6% dementia, 15.4% mild cognitive impairment) completed a 7-week CST program. The sample was diverse (46.2% White/Caucasian, 42.3% Hispanic/Latino, 7.7% Black/African American; 38.5% bilingual). Most frequent etiologies included mixed (26.8%), Alzheimer’s (23.1%), and vascular (19.2%). Ages ranged from 43–86 (M = 74.5; SD = 7.6). Pre-group/post-group assessment included Geriatric Depression Scale-Short Form (GDS-SF), Geriatric Anxiety Inventory (GAI), Neuropsychiatric Inventory (NPI-informant), Everyday Cognitive (ECOG), and Texas Functional Living Scale (TFLS). Analyses included paired-samples t-test and Wilcoxon signed-rank test. Results Post-group GAI scores were significantly lower (Median = 1) than pre-group scores (Median = 3), z = −2.574, p = 0.01, r = −0.515. There were no significant declines or improvements across other measures of neuropsychiatric symptoms. Measures of IADLs/everyday functioning also remained stable. Conclusions Consistent with prior studies, CST was effective in reducing anxiety symptoms of veterans with cognitive disorders. While measures of everyday functioning did not improve, performance and informant-report remained stable. CST presents a unique opportunity to impact both cognition and neuropsychiatric symptoms that may cause significant distress in veterans with dementia and their caregivers.

Evaluation of an interprofessional educational program in nursing home practice: a mixed methods multiple-case study

ABSTRACT Research has shown that interprofessional collaboration (IPC) and education (IPE) may potentially lead to better care for residents in nursing homes, but their implementation is challenging. This study evaluates the implementation of a co-designed IPE program and investigates what and how healthcare students learn and what factors influence their learning. A mixed-methods approach was used to evaluate three cases, with student participation in the IPE (n = 72). The study comprised pre- and posttests, focus groups, and interviews (n = 54). The results indicate that students developed their interprofessional skills and person-centered practice, as confirmed by both the students and educators in the interviews. Additionally, the findings suggest that others also learned from the program. The study emphasizes the influence of workplace learning culture, resources, organizational infrastructure for IPC, and educators’ embeddedness in the care organization on learning outcomes. The findings suggest that IPE is stimulated and accelerated by existing IPC and can stimulate or accelerate existing IPC. As the enabling factors are interrelated, addressing them simultaneously on all organizational levels may result in the faster development of an IPE-ready organization.

An Evaluation of the Transfer of Skills and Knowledge from Two World Federation of Societies of Anaesthesiologists Fellowship Programs.

Subspecialist training is an important part of developing human resources for health and for some learners, may require taking place in another, higher-resourced country. Despite effective learning of skills and knowledge in a different, more highly resourced context, transfer of these skills and knowledge back to a more poorly resourced context can be a challenge. We aimed to evaluate the transfer of skills and knowledge in 2 World Federation of Societies of Anaesthesiologists (WFSA) fellowship programs. This qualitative program evaluation study, guided by Guskey's evaluation framework, used in-depth interviews of both faculty and graduates of the 2 fellowship programs. Interviews were conducted remotely, transcribed verbatim, and analyzed using qualitative content and pattern analysis. We interviewed 2 administrators, 10 faculty members, 17 graduated fellows, and 3 graduated fellows now in the role of faculty member in that fellowship. Key themes were barriers and enablers to the transfer of skills, including workplace and staffing, resources, mentorship, the interprofessional team, and leadership. Graduated fellows were able to have an impact on returning home in the areas of practice and service development, research, and teaching. Our study found that the 2 fellowship programs had variable success in the transfer of learned skills and knowledge back to the fellows' "home" institutions. Contextual differences between the fellowship institution and the home institution were the main source of barriers to transfer, and fellows from different countries had diverse needs. Supporting the transfer of knowledge and skills should be an explicit goal of these fellowship programs, and as such, should be considered in the recruitment of fellows, curriculum development, and in how the success of a fellowship is evaluated. Curricula should not just focus on medical knowledge and skills, but also skills in leading change and in education.